Journal «Angiology and Vascular Surgery» • 

1998 • VOLUME 4 • №1

THE CHOICE OF AN APPROACH TO SURGICAL BLOOD FLOW CORRECTION IN SEVERE ISCHEMIA OF THE LOWER LIMBS

T.G. Gulmuradov, R.R. Rakhmatullayev, D.D. Sultanov, Sh.Yu. Valiyev
Chair of Hospital Surgery, Tajik Slate Medical University, Dushanbe,
Medical Hygiene Unit of the Aluminium Plant, Tursunwde, Republik of Tajikistan

The aim of the present work was a goal-oriented examination and surgical treatment of 90 patients with severe lower limb ischemia consequent on obliteration of the distal arterial bed. Of these, 75.5% suffered from atherosclerotic occlusion of the femoropopliteal-tibial segments; 24.5% were established to have thrombangiitis. All the patients were diagnosed to have chronic stage III-IV lower limb ischemia. As for the clinical symptoms, there prevailed rest pains (90% of patients), intermittent claudication on walking less than 25 m (61.8% of patients); ulcerative-necrotic lesions on the foot and toes were detected in 69%, foot edema in 50.9% of patients. Based on the etiology and condition of the distal arterial bed we divided our patients into 4 groups. It should be notedthatin 10 (11.1%) patients, the purpose of the reconstructive operation was to save the solitary limb, inasmuch the other one was amputated before because of gangrene. The method of limb revasculariwtion was chosen depending on the condition of the arterial bed. Direct arterial reconstruction was considered to be an operation of choice, provided not less than 2 calf arteries were patent. If the tibial artery alone was patent, the preference was given to direct arterial reconstruction with formation of an arteriovenous fistula in the area of the distal anastomosis by means of an additional pathway of arterial blood outflow. The patients with total obliteration of the distal arterial bed and the nonfunctioning plantar arch of the foot underwent arterialiwtion of the venous blood flow of the foot as an alternative to limb amputation. In the long-term postoperative period, 39.1% of patients with atherosclerotic lesion developed thrombosis of the zone a/reconstruction, with the number of saved limbs accounting for 71.8%. In thrombargiitis patients, thrombosis of the zone a/reconstruction was identified in 100% of cases, the recurrence of severe limb ischemia that entailed amputation was recorded in 20% of cases, the number of saved limbs constituted 80%.

P. 102-113

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